Direct debit requestThe quick and convenient way to pay

• Your payments will be automatically taken from your cheque or savingsaccount on the due date.

• Direct Debit can only be set up to take out payments monthly.

Please complete and return this form:

Direct Debit AdministrationPO BOX 940, Melbourne, VIC 3001

1300 369 905

Account Number

Full Name

Please make sure you read the direct debit service agreement on the following page.

Your details

Payment option

Details of account to be debited

Your authorisation

My preferred method of payment each month is (Please tick one box only):

Minimum monthly payment, plus any overdue and over limit amount

Fixed amount of (Minimum amount of $10)

OR Minimum monthly payment, plus any overdue and over limit amount (whichever is greater)

Full closing balance payment as shown on my account statement

(We can only accept bank account details that are in the sole name of the account holder or froma joint bank account includes the name of the account holder.)

I/We acknowledge that this direct debit arrangement is governed by the terms of the direct debit request service agreement overleaf. If thenominated bank account is a joint account, both account holders signatures are required.

I/We request Latitude Finance Australia (ABN 42 008 583 588) to debit the account described above with the amount of the paymentdue on my account as specified in the payment option schedule above.

Name of FinancialInstitution

Branch Name

Name of account tobe debited

(eg Name in which the account isHeld ie. John Smith)

Name

Signature

Date

BSB number

Account holder Joint account holder(If nominated bank account is a joint account)

Account number

GEGE000010_Web 01/16

Title First Name(s) Last Name

Direct Debit Request Service Agreement

The meaning of words printed like this in this Direct Debit RequestService Agreement is explained in 8 below.

1. Debiting your account

1.1 By signing a direct debit request, you have authorised us toarrange for funds to be debited from your account.

1.2 We will arrange for your financial institution to debit youraccount in accordance with your instructions given to us in thePayment Option Schedule. If, however, a debit payment is due ona day:

(a) which is not contained in a particular month; or

(b) which is not a business day,

then the debit payment will be made on the last day of that monthor on the preceding business day respectively. If you are uncertainas to when a debit payment will be processed, you should contactyour financial institution for assistance.

2. Changes by us

We may vary any details of this agreement or the direct debitrequest at any time (including cancelling it). We will give you noticein writing of any such change at least fourteen (14) days before thechange takes effect.

3. Changes by you

You may request to stop or defer a debit payment or alter,suspend or cancel the direct debit request at any time. Whenwe receive such a request, we will inform you of our notificationrequirements for such a request.

4. Your Obligations

4.1 It is your responsibility to ensure that there are sufficient clearfunds available in your account to allow a debit payment to bemade in accordance with the direct debit request.

4.2 If there are insufficient clear funds in your account to meet adebit payment:

a) you may be charged a fee and/or interest by yourfinancial institution;

(b) you may also incur fees or charges imposed or incurredby us, and

(c) you must arrange for the debit payment to be made byanother method or arrange for sufficient clear funds to be inyour account by an agreed time so that we can process thedebit payment.

4.3 You should check your account statement to verify that theamounts debited from your account are correct.

4.4 If we are liable to pay goods and services tax (“GST”) on asupply made by us in connection with this agreement, then youagree to pay us on demand an amount equal to the considerationpayable or the supply multiplied by the prevailing GST rate.

5. Dispute

5.1 If you believe that there has been an error in debiting youraccount, you should notify us immediately.

5.2 We will investigate and deal promptly and in good faith with anysuch query, claim or complaint. If your query, claim or complaintcannot be resolved to your satisfaction in that call, we will informyou at that time of the length of time which we estimate theinvestigation will take.

5.3 If we conclude as a result of our investigations that youraccount has been incorrectly debited we will adjust your account(including interest and charges) accordingly by directly creditingyour account or sending you a refund cheque at our discretion.We will also notify you of the adjustment either orally or in writing.

5.4 If we conclude as a result of our investigations that youraccount has not been incorrectly debited we will respond toyour query by providing you with reasons and any evidencefor this finding.

5.5 Any queries you may have about an error made in debitingyour account should be directed to us in the first instance so thatwe can attempt to resolve the matter between us and you. If wecannot resolve the matter you can still refer it to your financialinstitution which will obtain details from you of the disputedtransaction and may lodge a claim on your behalf.

6. Accounts

6.1 You should check:

(a) with your financial institution whether direct debiting isavailable from your account as direct debiting is notavailable on all accounts offered by financial institutions;

(b) that your account details which you have provided to usare correct by checking them against a recent accountstatement;

and

(c) with your financial institution if you are uncertain abouteither of the above matters before completing the directdebit request.

7. Confidentiality

7.1 We will keep any information (including your account details) inyour direct debit request confidential. We will make reasonableefforts to keep any such information that we have about you secureand to ensure that any of our employees or agents who haveaccess to information about you do not make any unauthoriseduse, modification, reproduction or disclosure of that information.

7.2 We will only disclose information that we have about you:

(a) to the extent specifically required or authorised by law; or

(b) for the purposes of this agreement (including disclosinginformation in connection with any query or claim); or

(c) with your implied or express consent.

8. Definitions

Account means the account held at yourfinancial institution from which weare authorised to arrange for funds tobe debited.

Agreement means this Direct Debit RequestService Agreement between youand us.

Business day means a day other than a Saturdayor a Sunday or a public holiday listedthroughout Australia.

Debit payment means a particular transaction wherea debit is made.

Direct debit request means the Direct Debit Requestbetween us and you.

Us, we or our means Latitude Finance AustraliaABN 42 008 583 588.

You means the person(s) who signed thedirect debit request.

Your financial institution means the financial institution whereyou hold the account that you haveauthorised us to debit.

Please keep this information for your own records

Credit provided by Latitude Finance Australia (ABN 42 008 583 588).Australian Credit Licence Number 392145